骨髓结核的临床特点分析并文献复习

发布时间：2018-04-04 00:45

本文选题：骨髓结核　切入点：临床特点　出处：《中国呼吸与危重监护杂志》2017年02期

【摘要】：目的探讨骨髓结核的危险因素、临床特点、诊断、治疗反应及预后,以提高对本病的认识。方法回顾性分析2004年1月至2014年12月四川大学华西医院收治的62例通过骨髓活检诊断骨髓结核的患者资料,包括临床表现、实验室资料、辅助检查、病理检查、治疗及预后随访等。结果本组患者中,男34例,女28例,发病年龄15~80岁,平均年龄(45.3±35.7)岁。21例(33.9%)伴有慢性疾病及脏器功能不全,包括晚期肾病、肝病、慢性呼吸疾病、风湿免疫系统疾病、糖尿病等。主要临床表现为发热61例(98.4%),症状缺乏特征性。实验室检查中,血常规提示白细胞减少、贫血或者血小板减少者有59例(95.2%),两系或三系同时减少38例(61.3%)。胸部影像学提示典型血行播散型肺结核22例(36.1%),继发性肺结核6例(9.8%),26例(42.6%)无典型结核征象。腹部影像学发现脾脏长大32例(55.2%),肝脏长大16例(27.6%),肝脾同时长大13例(22.4%)。62例患者均行骨髓相关检查,其中53例(85.5%)患者骨髓活检标本中查见肉芽肿病变,57例骨髓活检标本行抗酸染色,28例(49.1%)阳性。25例完成电话随访,因结核及并发症死亡8例。结论骨髓结核是播散性结核的组成部分之一,是肺外结核的少见类型,发热是常见的症状,临床表现及实验室检查缺乏特异性,血常规提示白细胞减少、贫血或者血小板减少,可作为重要线索,骨髓组织活检是确诊本病的主要手段。不明原因发热患者应警惕此病,并尽早完善骨髓活检。由于骨髓结核感染部位的特殊性,常常引起白细胞减少,导致患者合并其他病原体感染,更容易造成不良结局,因此,提高对本病的认识,及早地明确诊断,进行针对性的治疗,有助于改善预后。
[Abstract]:Objective to investigate the risk factors, clinical features, diagnosis, treatment response and prognosis of bone marrow tuberculosis.Methods from January 2004 to December 2014, 62 patients with bone marrow tuberculosis diagnosed by bone marrow biopsy, including clinical manifestation, laboratory data, auxiliary examination and pathological examination, were retrospectively analyzed.Treatment and prognosis were followed up.Results there were 34 males and 28 females. The onset age was 1580 years (mean age: 45.3 卤35.7) years. 21 cases were associated with chronic diseases and organ dysfunction, including advanced nephropathy, liver disease, chronic respiratory disease, rheumatic immune system disease, diabetes mellitus and so on.The main clinical manifestations were fever in 61 cases (98.4%) and lack of characteristic symptoms.In laboratory examination, 59 cases of leukopenia, anemia or thrombocytopenia were detected by blood routine examination, and 38 cases of two or three departments were reduced by 61.3% at the same time.Chest imaging showed that there were no typical tuberculosis signs in 22 cases of disseminated pulmonary tuberculosis by blood and 6 cases of secondary pulmonary tuberculosis in 26 cases (42.6%).Abdominal imaging showed that the spleen grew up in 32 cases, the liver grew in 16 cases, the liver grew up in 16 cases, and the liver and spleen grew at the same time in 13 cases. The bone marrow correlation examination was performed in all cases.Among the 53 bone marrow biopsy specimens, 57 cases were found to have granulomatous lesions and 28 cases were positive for acid-fast staining. 25 cases were followed up by telephone. 8 cases died of tuberculosis and complications.Conclusion Bone marrow tuberculosis is one of the components of disseminated tuberculosis, is a rare type of extrapulmonary tuberculosis, fever is a common symptom, clinical manifestations and laboratory examination lack specificity, blood routine examination indicates leukopenia, anemia or thrombocytopenia.As an important clue, bone marrow biopsy is the main method to diagnose the disease.Patients with fever of unknown origin should be on guard against this disease and improve bone marrow biopsy as soon as possible.Because of the particularity of the site of infection of bone marrow tuberculosis, leukopenia is often caused, which leads to the patients complicated with other pathogens, and it is more likely to result in adverse outcomes. Therefore, to raise the awareness of the disease and to make a definite diagnosis as soon as possible,Targeted treatment is helpful to improve prognosis.
【作者单位】：四川大学华西医院呼吸与危重症医学科;
【分类号】：R52

【参考文献】